title: Quality of life and female sexual function after skinning vulvectomy with split-thickness skin graft in women with vulvar intraepithelial neoplasia or vulvar Paget disease.
abstract: OBJECTIVE
  Vulvar intraepithelial neoplasia (VIN) and vulvar Paget disease are managed with either vulvectomy, destructive treatments (laser, antimitotic drugs) or immunostimulants. All these options are associated with functional complications. The purpose of this study was to evaluate the surgical technique consisting of skinning vulvectomy with split-thickness skin graft, and its effect on overall quality of life and sexual function.
  
  
  METHODS
  A retrospective study was conducted on thirteen patients who underwent skinning vulvectomy with split-thickness skin graft between 1999 and 2009. Overall quality of life and sexual function were assessed with the Medical Outcome Study Short Form 36 (MOS SF-36) and Female Sexual Function Index (FSFI), respectively.
  
  
  RESULTS
  The median age of patients was 54 (range: 33-77) years. Three patients had Paget disease and 10 patients had VIN lesions. The excision margins were clear in 46% of cases. The incidence of occult cancer was 31%. The mean follow-up period was 77 (±35) months. Four patients experienced a relapse of their intraepithelial disease. The mean disease-free survival was 58 (±44) months. There was no significant difference in MOS SF-36 scores between the study population and the general population. The patients assessed with the FSFI regained normal sexual function after the surgical procedure.
  
  
  CONCLUSIONS
  Skinning vulvectomy with split-thickness skin graft is a feasible technique yielding good results in terms of quality of life and sexual function. It enables occult cancer to be diagnosed in patients with VIN or Paget disease.
authors.affiliation: Department of Gynecology, Rennes University Hospital, 16 rue de Bulgarie, B.P. 90347, F-35203 Rennes Cedex 2, France; Department of Surgery, Eugène Marquis Comprehensive Cancer Center, Av Bataille Flandres-Dunkerque C.S. 44229, F-35042 Rennes Cedex, France. Electronic address: vincent.lavoue@chu-rennes.fr.
authors.forename: V
authors.initials: V
authors.lastname: Lavoué
authors.forename: A
authors.initials: A
authors.lastname: Lemarrec
authors.forename: N
authors.initials: N
authors.lastname: Bertheuil
authors.forename: S
authors.initials: S
authors.lastname: Henno
authors.forename: H
authors.initials: H
authors.lastname: Mesbah
authors.forename: E
authors.initials: E
authors.lastname: Watier
authors.forename: J
authors.initials: J
authors.lastname: Levêque
authors.forename: K
authors.initials: K
authors.lastname: Morcel
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010145:Paget Disease, Extramammary / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012725:Sexual Behavior; D016038:Skin Transplantation; D011795:Surveys and Questionnaires; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Quality of life; Skin graft; Vulvar Paget disease; Vulvar intraepithelial neoplasia; Vulvectomy